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Virulent stage @ 37C

Yeast, Histoplasma capsulatum

Saprophytic stage has thick spherical macroconidia and small oval microconida

Histoplasma capsulatum

Not transmitted from person to person, grows from bird and bat ****, Ohio/Mississippi Valley

Histoplasma capsulatum

Inhaled and lives in alveolar macrophages, suppresses oxidative response, modulate phagolysosome pH

Histoplasma capsulatum

Causes acute, mediastinitis, pericarditis, chronic pulmonary, and disseminated infections

Histoplasma capsulatum

Immunosuppressed, infants, reticuloendothelial system

Acute disseminated Histoplasma capsulatum

More focal, mucous membrane lesions

Chronic disseminated Histoplasma capsulatum

Microconidia bind CD11/CD18 receptors of alveolar macorphages

Histoplasma capsulatum

Thick walled chlamydospores

Blastomyces Dermatitidis

On blood agar, wrinkled and folded glabrous and yeast-like

Blastomyces Dermatitidis

Broad based budding yeasts

Blastomyces Dermatitidis

Warm humid temperatures, rotting wood, decaying organic material

Blastomyces Dermatitidis

South central states and boarders of great lakes

Blastomyces Dermatitidis

Histopathology reflects mized granulomatous and pyogenic response, BAD-1 or WI-1 glycoproteins

Blastomyces Dermatitidis

Causes pulmonary dry cough/nodes, disseminated causes lesions all over skin

Blastomyces Dermatitidis

Life threatening fungal infections are treated with

Amphotericin B

Mild or moderate fungal infections are treated with

Intraconazole

Southwestern regions of united states

Coccidio immitis

Grows as a saprobe in alkaline desert soil

Coccidio immitis

At 37C, in tissue develops into spherules

Coccidio immitis

Has this life cycle Hyphae → Arthrospore → Spherule → Endospores

Coccidio immitis

Growth evident in 3-5 days

Coccidio immitis

Bird ****, polysaccharide capsule, AIDS, meningitis, lumbar puncture, encapsulated budding yeast

Cryptococcus Neoformans

Neutropenic, angioinvasive, 45 degree branching, fluffy green colonies

Aspergillus fumigates

Nonseptate hyphae, branch at 90 degrees, diabetes with ketoacidosis

Zygomycosis

Protozoan, inhaled from environment, T cell deficiency, foamy proteinacious material, hypoxemis

Pneumocystosis

Toronto Canada and Hong Kong

SARS

FEVER, myalgia, headache, mild diarrhea, DRY COUGH, atypical pneumonia, novel corona virus

SARS

Fever, lower respiratory tract infection, 10 days of travel or contact

Suspect case of SARS

Fever, lower respiratory tract infection, 10 days of travel or contact + CXR of pneumonia or ARDS

Probable case of SARS

Best test for SARS diagnosis

Acute and convalescent serum Ab titiers, PCR

Gene mutation on chromosome 7, common lethal genetic disorder whites

Cystic fibrosis

Defective CFTR protein production

Class 1

Defective CFTR protein processing

Class 2, delta F508

Defective regulation of CFTR

Class 3

Defective conduction of CFTR

Class 4

Chronic sinusitis, nasal polyps, chronic bronchial suppuration, pancreatitis, DM, reduced fertility

Cystic fibrosis

Diagnostic for CF

>60 mMol/L

Newborn screening marker for CF

Immunoreactive trypsinogen (IRT)

Common CF respiratory pathogens

pseudomonas, S. aureus, H. influenza

CF, gram positive, coagulase positive

Staph Aureus

CF, aerobic, non-spore-forming, gram negative rods, non-fermenter, mucoid, ↓ FEV1

Pseudomonas Aeruginosa

Helps CFTR fold right way so channel works

Corrector

Helps the channel open

Potentiator, VX-770

Dew drop on rose pedal, itchy, vesiculopustular rash, bilateral infiltrates

Varicella Zoster Virus

DS DNA herpes virus, latency shingles, positive TSANCK smear, treat with acyclovir

Varicella Zoster Virus

Secondary infection associated with Varicella Zoster Virus

GROUP A STREP PYOGENES

Nasal flaring, fever, nose crusting, hyperinflation, bilateral patchy infiltrates, paramyxovirus, winter or spring, humans only

RSV

Blue white dots in mouth

Koplick spots, Measles

Barking, photosensitive, cough → coryza → conjunctivitis → kopliks → rash, desquamation

Measles

Paramyxovirus, contagious 1-2 days before onset of symptoms, treat with vitamin A and supportive care, 2 vaccinations

Measles

Clear nasal drainage, bulging TM's, fever, cough

Otitis media

3 pathogens for otitis media and acute sinusitis

S. Pneumo, H. Influ, M. Catarralis

Bulging, bacteria, antibiotic treatment

Acute Otitis Media

Retracted, prominent short process, no antibiotics

Middle Ear Effusion

Collection of squamous epithelium and keratin in ear

Colesteotoma

Cold symptoms for 3 weeks, cobble stoning posterior pharynx, dark circles under eyes, clinical diagnosis

Acute sinusitis

Water's view X-ray, fluid line, treat with antimicrobials for 20-21 days

Acute sinusitis

Gram negative, aerobic bacillus, acid-fast, highly communicable, URI

Bordetella pertussis

Begins with URI, infective during this stage, if treated you stop the progression

Catarrhal phase of pertussis

Progresses to severe coughing with whoop followed by vomiting

Paroxysmal stage of pertussis

Why petussis cases are increasing

acellular pertussis vaccine, wears out in 7-10 years

Tropics/subtropics, streaks down leg, swollen feet/scrotum, diagnose at night, TX- DEC or ivermectin

Wuchereria Bancrofti Lymphatic Filariasis

Asia/South Pacific, streaks down leg, swollen feet/scrotum, diagnose at night, TX- DEC or ivermectin

Brugia Malayi Lymphatic Filariasis

Spaces between tail tips

Brugia Malayi

Running water, lose vision, nematode

Onchocerca Volvulus

Simulium fly transmits larvae, adult worm nodules, microfilaraie in skin, worm in eye, skin snip test

Onchocerca Volvulus

Numerous lesions in CT scan of brain, consume taneia solium eggs (pork tapeworm), TX-praziquantel, albendazole & corticosteroids

Cysticercosis/Neurocysticercosis

Hyatid cyst, tapeworm in dogs, ship liver, TX- albendazole and cyst removal

Echinococcosis

Fever, malaise, rash, ↑ LIVER ENZYMES, separate male and female, adult in veins of large intestine and liver

Schistosoma Mansoni

Transmitted by free-living cercarie, rash at entry sight, typhoid fever like symptoms, hypatospleenomegaly

Schistosoma Mansoni

Lateral spine

Schistosoma Mansoni

Painful urination, hematuria, swam in river, penetration of skin by free living cercariae, bladder biopsy

Schistosoma Haematobium

Terminal spine

Schistosoma Haematobium

Spleenectomy, sporozoan, infects RBC's, deer tick, northeast, tiny rings with cross formation, TX- clindamycin and quinine

Babesia Microfti

Large cervical lymph nodes, cats, oocyst, tachyzoite in tissue, tissue and brain damage, ↑ IgM titer, TX- pyrimethamine

Toxoplasma Gondi

Iraq, flagellate, phebotomus sand fly, amastigote in tissue/macrophages, TX- antimony-containing compounds

Leishmania species

Middle east, dry long lasting lesions, Tropica, Major, Mexicana, Bazillensis

Cutaneous Leishmania

India, Brazil, spiking fevers, sweat, diarrhea, weight loss, organomegaly, anemia, Donovani, Tropica

Visceral Leishmania

Megacolon, megaesophagus, reduvid bug, tryptomastigote, South and Central America, CHAGA's, ROMANIA SIGN

Trypanosoma Cruzi

Chaga's disease, Chagoma (chancre) at site of bite

Trypanosoma Cruzi

Unilateral swelling of face where bitten

Trypanosoma Cruzi, ROMANIA SIGN

Swollen nodes on back of neck (winterbottom's sign), tetse fly, trypomastigote, can get in CNS

Trypanosoma Brucei

β hemoplitic, G+ cocci in pairs and chains

Group A Streptococcal Pyogenes

Rheumatic fever and acute glomerulonephritis

acute non-suppurative sequealae of GAS

Palatal petichiae

GAS pharyngitis

Strawberry tongue, circumoral pallor, sandpaper rash, pastia lines on arms, desquamation

Scarlet Fever

Holosystolic murmur, hepatomegaly, mitrial > aortic > tricuspid, carditis, polyarteritis, erythema, chorea, subcutaneous nodules, blanching rash

Rheumatic Fever due to GAS

Can see ring and gametocyte stages, rings and dots, 2/3 of RBC's size

Plasmodium Falciparium

Large RBC's, fever, chills, ↓ Hb, spleenomegaly, big red dots in cells, funny shapes

Plasmodium Viviax

More common in non-immune mothers, placenta gets full of parasites

Congenital malaria

Transmission of malaria

bite of female anopheles, bite from dusk to dawn, sharing needles, transfusion, mother → infant

Half malaria cases, 95% of deaths

Plasmodium Falciparum

Prefers reticulocytes but can invade RBC's of all ages

Plasmodium Falciparium

Invades reticulocytes

Plasmodium falciparum, vivax, and ovale

Preferentially invades senescent erythrocytes

Plasmodium Malariae

Types of plasmodium that persist in the liver

Ovale and Vivax

How do you treat plasmodium that is stuck in liver

PRIMAQUIN (ovale and vivax)

What causes malaria fevers

cyclical RBC lysis, release of TNFα and other inflammatory cytokines, cyclical

Some pathogenesis of malaria

hemolytic anemia, thrombocytopenia, adherence to chondrotin sulfate → low birth weight

Two properties that make falciparum dangerous

high degree of parasitemias, CO-ADHERENCE (stick RBC's together by making proteinaceous knobs → clog up blood vessels), also hit all RBC's

Treat plasmodium falciparum (assume resistance)

malarone, quinine, clindamycin, tetracycline

Treat plasmodium vivax

chloroquine

Pathogenic bacteria of the small intestine

Vibrio Cholerae, Vibrio Vulnificus

Pathogenic bacteria of large intestine

Vibrio Parahaemolyticus

Small intestine, enterotoxin or adherence, N/V fever, fluid loss, 1-3 days, self-limiting

non-inflammatory watery disease

Colon, small intestine, invasion or cytotoxin, fever, abdominal pain, cramps, vomiting, blood in stool, 2-7 days

inflammatory diarrhea

Hemolysin/T3S

Vibrio Parahaemolyticus

Adherence/CT

Vibrio Cholerae

Gram negative curved rod, motile, facultative anaerobe, non-lactose fermenter, grows in SALT and FRESH water

Vibrio Cholerae

Grows in salt and fresh water

Vibrio Cholerae

Serotype of cholera that causes more epidimcs

Serotype O1

Serotype of cholera that emerged from India

Serotype O139

Ongoing cholera pandemic

EI Tor

Severe watery diarrhea, rice water stool, isolate organism in stool:

Vibrio Cholerae

Virulence factors of Vibrio Cholera

flagellum, Tcp (pili), AB enterotoxin

Filamentous phage

Tcp pili virulence factor of vibrio cholera

CTX phage

AB cholera enterotoxin

ADP ribosylates Gs protein, causes Gs activation, ↑ cAMP

cholera AB toxin

Contract from contaminated shelfish

Vibrio Parahaemolyticus

Found only in salt water

Vibrio Parahaemolyticus

Gram negative, halophilic small rods, swimming flagella, survives in marine sediment

Vibrio Parahaemolyticus

TDH/TLH thermostable hemolysins, two type III secretion systems (T3S1, T3S2)

Vibrio Parahaemolyticus

Linked to handling/eating raw oysters

Vibrio Vulnificus

Sepsis, bullous skin lesions, hypotension ,fever, GI

Vibrio Vulnificus

Wound exposure to contaminated water, necrotizing wound lesion

Vibrio Vulnificus

Acid induced oxidative stress, CPD capsule, iron acquisition, RtxA1 toxin

Virulence Factors of Vibrio Vulnificus

Low temperature pasteurization, high-pressure processing, irridation of oysters

AMERIPURE

Invasive infection, gram negative rods, facultative anaerobes, non-lactose fermenter, motile, cause gastroenteritis/septicemia/enteric fever, improper food handing or processing, fluid and electrolyte replacement, no ABX

Salmonella

Contaminated food or water, human carriers, bacteria multiply in macrophages, fever, HA, lethargy, myalgia, rose rash on abdomen, re-infection of intestinal tract, invasive disease treated with antibiotics, produce SOD and catalase, resistant to complement, LPS, T3S, spreads to other organs

Enteric Typhoid Fever caused by Salmonella Typhi

Invasive and toxigenic, resistant to several Abx, gram negative facultative rods, non-motile, group based on O antigen, contaminated food/water, causes dysentery, bacteria directed endocytosis through M cell proteins

SHIGELLA

N-glycosidase, cleaves adenosine residue, stops cell protein synthesis, enetotoxin (fluid loss), neurotoxin (paralysis), cytotoxin (cell death), important role in Hemolytic Uremic Syndrome

Shiga Toxin (Stx)

Acute kidney failure, more common in children, hemolytic anemia, thrombocytopenia, caused by shigella

Hemolytic Uremic Syndrome (HUS)

Gram negative curved rod, motile, slow growing, lives in gastric mucosa, acute or chronic inflammation in gastic mucosa, gastritis, nausea, vomiting, epigastic pain, flagella, urease (creates alkaline stomach), LPS, VacA, cag, ↑ Gastrin, ↑ free radicals, ↑ proliferation, ↓ ulcers

Helicobacter Pylori

Gram-negative rod, motile, facultative anaerobe, ferment lactose, serotype O, H, K, virotype based on virulence factors, transmitted in food and water, fever, dehydration

E. Coli

Watery non-inflammatory diarrhea, non-toxigenic/non-invasive, T3S, LEE PAI, bundle-forming-pilus (EAF), infants, food, water, lactose fermenter, DNA probe detects bfp, tx-non-absorbable aminoglycosides

EPEC (pathogenic)

Watery non-inflammatory diarrhea, Heat Labile Toxin (LT), Heat Stable Toxin (ST), colonization factor antigen fimbrae, traveler's diarrhea, tx- Trimethoprim-sulfmethoxazole

ETEC (toxigenic)

Cholera like AB toxin, ADP ribosylates Gs, stimulates PG, LT, cytokines

Heat Labile Toxin (LT), ETEC

Non-inflammatory or inflammatory bloody diarrhea, biofilm, AIDS, aggregative adherence fimbrae (AAF), EAST1, Pet, tx- ciprofloxacin, rifaximin, phenotypic Hel-2-adhearance assay

EAEC (aggregative)

Virulence factor for EAEC, stacked brick aggregates, adherence to epithelial cells

Aggregative Adherence Fimbriae (AAF)

Virulence factor for EAEC, cytotoxic serine protease autotransporter, disrupts actin, induces exfoliation

Pet

Inflammation, necrosis, ulceration, dysentery, non-toxigenic, invasive, get into colon via M cells, use T3S, shigella like organism, food, water

EIEC (invasive)

Dysentery, progresses to HUS, Triad of symptoms (RBC destruction, thrombocytopenia, acute renal failure), Sxt (shigella like toxin), T3S LEE PAI, EAST1, contaminated beef, 0157:57 (most active serotype), delayed sorbitol fermentation, DNA fingerprinting, Tx- NO ABX, use transfusion/hemodialysis

EHEC (hemorrhagic)

Gram positive rods associated with GI disease

Anaerobes (C.Diff, C. Perfringens), Obligate Aerobes (B.Cereus, B.Anthracis)

Obligate anaerobes, spore formers, no catalase/peroxidase/SOD, look like tennis rackets, AIDS, hemophilia, trimethoprom-sulfamethoxazole cause diarrhea, large intestine has pseudomembrane, yellow lesions on mucosa, toxins A/B/binary toxin CDT, immunological tests for B, can't culture, Tx- VANCOMYCIN

E.coli

Inactivate Rho GTPases by glucosylation, causes cytoskeletal disruption

C.Diff toxins A and B

New virulent strain, produces a lot of toxins A and B (due to deletion of TcdC), new CDT cytotoxin

NAP-1/027 Virulent Strain

Anaerobic, Diarrhea, abdominal camps, vomiting, corned beef, germinate and multiply in fod at RT, ingested spores make enterotoxin, tight junction proteins CLAUDIN3 and CLAUDIN4

Clostridium Perfringes

Rice, quick onset of N/V/D, gram positive rod, spore former, aerobe, heat stable toxin (triangle), 2 heat labile enterotoxins, aerobe

Bacillus Cereus

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